|
HCHG OT THER ADAPT FU 15 MIN
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
H4300272
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.47 |
| Max. Negotiated Rate |
$238.59 |
| Rate for Payer: AlohaCare Medicaid |
$120.50
|
| Rate for Payer: AlohaCare Medicare |
$216.90
|
| Rate for Payer: Cash Price |
$156.65
|
| Rate for Payer: Cash Price |
$156.65
|
| Rate for Payer: Devoted Health Medicare |
$238.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$216.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.95
|
| Rate for Payer: Health Management Network Commercial |
$204.85
|
| Rate for Payer: Humana Medicare |
$216.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$122.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.90
|
| Rate for Payer: MDX Hawaii PPO |
$233.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$216.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$216.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$216.90
|
| Rate for Payer: University Health Alliance Commercial |
$175.66
|
|
|
HCHG OT THERAPEUTIC ACTIVITY 15 MIN
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
H4300196
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
|
|
HCHG OT THERAPEUTIC ACTIVITY 15 MIN
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
H4300196
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$243.54 |
| Rate for Payer: AlohaCare Medicaid |
$123.00
|
| Rate for Payer: AlohaCare Medicare |
$221.40
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Devoted Health Medicare |
$243.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.70
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$221.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.40
|
| Rate for Payer: University Health Alliance Commercial |
$179.31
|
|
|
HCHG OT THERAPEUTIC EXERCISE 15 MIN
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
H4300206
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
HCHG OT THERAPEUTIC EXERCISE 15 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
H4300206
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$209.88 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$190.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$209.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$190.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.80
|
| Rate for Payer: University Health Alliance Commercial |
$154.53
|
|
|
HCHG OVA & PARASITES CONC & ID
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
H3060342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$159.08 |
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.60
|
| Rate for Payer: MDX Hawaii PPO |
$159.08
|
|
|
HCHG OVA & PARASITES CONC & ID
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
H3060342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$162.36 |
| Rate for Payer: AlohaCare Medicaid |
$82.00
|
| Rate for Payer: AlohaCare Medicare |
$147.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Devoted Health Medicare |
$162.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.90
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Humana Medicare |
$147.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.60
|
| Rate for Payer: MDX Hawaii PPO |
$159.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.60
|
| Rate for Payer: University Health Alliance Commercial |
$23.00
|
|
|
HCHG OXCARBAZEPINE AS METAOLITE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
H3011364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG OXCARBAZEPINE AS METAOLITE
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 80183
|
| Hospital Charge Code |
H3011364
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG OXIMETRY CONTINUOUS
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
H4600126
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$820.25 |
| Max. Negotiated Rate |
$936.05 |
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$868.50
|
| Rate for Payer: MDX Hawaii PPO |
$936.05
|
|
|
HCHG OXIMETRY CONTINUOUS
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
H4600126
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$955.35 |
| Rate for Payer: AlohaCare Medicaid |
$482.50
|
| Rate for Payer: AlohaCare Medicare |
$868.50
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Devoted Health Medicare |
$955.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$164.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$868.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$916.75
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Humana Medicare |
$868.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$868.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$492.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$868.50
|
| Rate for Payer: MDX Hawaii PPO |
$936.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$868.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$868.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$868.50
|
| Rate for Payer: University Health Alliance Commercial |
$703.39
|
|
|
HCHG OXYGEN PER DAY
|
Facility
|
OP
|
$639.00
|
|
| Hospital Charge Code |
K2700001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$632.61 |
| Rate for Payer: AlohaCare Medicaid |
$319.50
|
| Rate for Payer: AlohaCare Medicare |
$575.10
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Devoted Health Medicare |
$632.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$575.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$607.05
|
| Rate for Payer: Health Management Network Commercial |
$543.15
|
| Rate for Payer: Humana Medicare |
$575.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$575.10
|
| Rate for Payer: MDX Hawaii PPO |
$619.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$575.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$575.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$575.10
|
| Rate for Payer: University Health Alliance Commercial |
$465.77
|
|
|
HCHG OXYGEN PER DAY
|
Facility
|
IP
|
$639.00
|
|
| Hospital Charge Code |
K2700001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$543.15 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Health Management Network Commercial |
$543.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.10
|
| Rate for Payer: MDX Hawaii PPO |
$619.83
|
|
|
HCHG P190 BCR-ABL1
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
H3011598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$673.20 |
| Max. Negotiated Rate |
$768.24 |
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Health Management Network Commercial |
$673.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$712.80
|
| Rate for Payer: MDX Hawaii PPO |
$768.24
|
|
|
HCHG P190 BCR-ABL1
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
H3011598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.19 |
| Max. Negotiated Rate |
$784.08 |
| Rate for Payer: AlohaCare Medicaid |
$396.00
|
| Rate for Payer: AlohaCare Medicare |
$712.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Devoted Health Medicare |
$784.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$181.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$712.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$193.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.84
|
| Rate for Payer: Health Management Network Commercial |
$673.20
|
| Rate for Payer: Humana Medicare |
$712.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$712.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$403.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$712.80
|
| Rate for Payer: MDX Hawaii PPO |
$768.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$712.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$712.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$712.80
|
| Rate for Payer: University Health Alliance Commercial |
$167.07
|
|
|
HCHG PAP IN FLD(NEOPATH/MAN RESCRN)
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
H3110228
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$406.89 |
| Rate for Payer: AlohaCare Medicaid |
$205.50
|
| Rate for Payer: AlohaCare Medicare |
$369.90
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Devoted Health Medicare |
$406.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.61
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Humana Medicare |
$369.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.90
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$369.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.90
|
| Rate for Payer: University Health Alliance Commercial |
$68.47
|
|
|
HCHG PAP IN FLD(NEOPATH/MAN RESCRN)
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 88175
|
| Hospital Charge Code |
H3110228
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$398.67 |
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
|
|
HCHG PAP SYSTEM DAILY
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4128107
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG PAP SYSTEM DAILY
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4128107
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG PAP SYSTEM SUBSEQUENT
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4128108
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG PAP SYSTEM SUBSEQUENT
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4128108
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG PARANEOPLASTIC AUTOANTIBODY EVAL, CSF - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG PARANEOPLASTIC AUTOANTIBODY EVAL, CSF - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HCHG PARE/CUT BENIGN SKIN LESIONS
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
H4500580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$847.45 |
| Max. Negotiated Rate |
$967.09 |
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.30
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
|
|
HCHG PARE/CUT BENIGN SKIN LESIONS
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
H4500580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$498.50
|
| Rate for Payer: AlohaCare Medicare |
$897.30
|
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Devoted Health Medicare |
$987.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$897.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$947.15
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: Humana Medicare |
$897.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.30
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$897.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.30
|
| Rate for Payer: University Health Alliance Commercial |
$726.71
|
|
